Fencing of water bodies (excl. pools) to prevent drowning in children

Conclusion: Indications for effectiveness

Fencing has mostly been evaluated in relation to swimming pools (see Evidence Statement 'Pool fencing to prevent drowning in children (product)', on which is concluded that there are indications that pool fencing can significantly reduce the risk of drowning, in particular 4-sided insolation fencing (enclosing pool only) as the safest option. Di Guiseppi et al. (2010) have concluded that the use of 3-sided pool fencing instead of complete 4-sided pool fencing is not effective and may actually increase risk because caregivers may believe that the incomplete fencing is adequate. For other water bodies, like ponds or wells, this kind of fencing is less extensively evaluated. Some controlled trials on the effectiveness of different types of fencing were found though, as described in this Evidence Statement.

Based on a study of general child safety barriers (Engdahl et al., 2009) we conclude that children's ability to climb fences varies with different types of fence. In an experimental setting Engdahl et al. concluded that simple barriers of heights 1.1-1.2 metres can be climbed by half of 4-6 year olds. The most effective barrier is this study is the one which is inclined towards the climber.

In a controlled trial Rabonivich et al. (1994) found that children as young as or younger than three years old are routinely capable of quickly climbing the most commonly used chain-link fence, even up to 5 ft high. A roller top treatment did not influence the children's ability to climb this fence. A wide-angled plate was a more effective barrier that the roller. However, the rates of children's succeses in overcoming the common chain-link fence with the wide-angled plate top treatment were still unacceptably high to be considered as a countermeasure for this type of fence. A small-chain link fence was also relatively easy for children to climb, especially for those over 3.5 years. A small proportion of children in the youngest age ranges were able to climb the fence at 4.5- and 5-ft. heights. The rates of succes for picket and stockade fences were lower than for chain-link fences. Some of the children in the sample were able to scale the stockade fence at 4ft; however there were no successes at 5-ft height. Interestingly, there were higher rates of succes for the stockade fence with the addition of the wide-angled plate top treatment for 42- to 48-month-olds. An ornamental iron fence had the lowest rates of success across this study; there were no successes at the 5-ft height.

A controlled trial by Cordovil et al. (2009) among children from 19 to 75 months also showed that as ages increased, children became more skilful in crossing the barriers. In the younger group, the most difficult barrier could prevent crossing in 90% of the cases; in the older group the more complex barrier allowed crossing for one third of the sample. The results indicated that increased height reduced the percentage of success in crossing and delayed time to cross. Barriers with horizontal bars, which provided footholds, were easier to cross and took less time to be crossed than panel barriers of the same height. In barriers with footholds, the existence of a cylinder rod rotating inwards reduced the crossing probability and delayed it. However, in solid panel barriers it facilitated climbing, as it offered additional grasping support. The most efficient barrier in this study was the 1.50-m solid panel. When children are able to cross barriers they can do it very rapidly. In this study, 94,3% of all succesful crossings occured in less than 30s.

These studies lead to the conclusion that certain types of fencing of water bodies (high, solid panels, ornamental iron fences) may lead to a reduction of incidents, but findings also reinforce the need for an appropriate adult supervision around risky environments to prevent children in drowning. Supervisors should not totally rely on barriers to prevent acces to dangerous places.

WHO world report of child injury prevention (2008) states that in low-income and middle-income countries, creating barriers between young children and the bodies of water to which they are exposed can be an effective measure to prevent drowning. Covering wells or open barrels with grills, creating an embankment or fenced barrier near ponds and riverbanks, and building flood-control embankments, are all effective in preventing drowning (Celis, A., 1997). Similarly, creating fencing around a dwelling where there is a hazard of open water outside the house can also provide protection. Affordability and availability are factors that may determine whether interventions are implemented.

Recommendations (for research & practice)

For practice and policy
Rabonivich et al. (1994): An ornamental iron fence may be an especially good choice, because in addition to being difficult to climb, it also affords excellent vision through the fence, which can improve supervision.

Waterside safety guidelines from the European Child Safety Alliance (Norman et al., 2008) suggests site managers can consider modifications to hazards, such as handrails along stairs, or barriers around risky areas for falls.

WHO Guidelines (2003) advice adjacent fencing (e.g., of docks and piers) as preventive and management actions to prevent injuries; In recreational water use areas, where certain locations or subareas may present significant continuous hazards to human health—for example, due to currents, weirs or rocks, access may be discouraged or prevented by a combination of one or more interventions, such as signing, fencing and lifeguard supervision.

Review Date: 04/03/2011
Version: 1.1
Status: Publish

Procedure
Articles (reviews) and reports were included that were published between 1990 and 2010, in English and Dutch. The outcomes of the study were reviewed by the Dutch Consumer Safety Institute.

Strategy: An online literature search was performed by a researcher of the Consumer Safety Institute and after this a more thorough search was performed by the documentation centre of CSI (Catalog CenV, Pubmed, Injury lit, Google, Websites, 'Grey' literature). Results of each search were compared on differences and potential missed studies were added. First the titles and then abstracts were scanned in order to include relevant studies. In the case of insufficient information obtained from abstracts the full text articles were obtained. Relevant articles were scrutinized and background documents were created. In addition, relevant references of included articles were checked on new and relevant articles (i.e., snowball search).

The outcomes of the study were reviewed by an expert in the field of child safety in the summer of 2011.

Background documents

Child safety barriers (version 1.0)
Ann-Sofie Engdahl, Patrik Spånglund, Erica Waller (2009)

Young children's ability to climb fences (version 1.1)
Beth A. Rabinovich, Neil D. Lerner, Richard W. Huey (1994)

An analysis of risk factors of non-fatal drowning among children in rural areas of Guangdong Province, China : a case-control study (version 1.0)
Wen Jun Ma, Shao Ping Nie, Hao Feng Xu ...[et al.] (2010)

Guidelines for safe recreational water environments : volume 1. coastal and fresh-waters (version 1.0)
(2003)

Protecting children and youths in water recreation : safety guidelines for service providers (version 1.4)
N. Norman, J. Vincenten (2008)

The efficacy of safety barriers for children : absolute efficacy, time to cross and action modes in children between 19 and 75 months (version 1.0)
R. Cordovil, J. Barreiros, F. Vieira ...[et al.] (2009)

World report on child injury prevention (version 1.0)
Eds. Magie Peden, Kayode Oyegbite, Joan Ozanne Smith ...[et al.] (0)

Housing interventions and control of injury-related structural deficiencies : a review of the evidence (version 1.0)
Carolyn DiGuiseppi, David E. Jacobs, Kieran J. Phelan ...[et al.] (2010)